Should I have one or two intrauterine inseminations?

Posted by & filed under Eggs, Sperm.

If your underlying concern is around serious male factor subfertility, or blocked/compromised tubes (as can happen with endometriosis), or serious concerns around egg quality, then IVF is by far the better choice for achieving pregnancy.

Not everybody needs IVF. Many patients may benefit from intrauterine inseminations.

IUI, where sperm is washed and placed high within the womb, can address a variety of concerns including:

  • concerns around cervical mucus or scarring after a LEEP procedure
  • erection concerns
  • difficulty timing intercourse (perhaps due to work, or irregularity of ovulation)
  • unexplained infertility
  • donor sperm
  • financial: And understanding that IVF may be “better”, but it is also much more expensive and invasive, and a hoped for success through a trial of inseminations

As you can see, there’s a wide variety of reasons why people may choose IUI, so success rates vary greatly from less than 5% to over 20% per cycle. You would really need to speak with your clinical team to understand what the odds of inseminations may be like for you.

It can be difficult to make sense of these wide-ranging numbers. Specific questions of what approach will maximize pregnancy rate can be actually quite tricky to answer. Here are two:

 

1. Should we always trigger ovulation?

 

One of the advantages of inseminations is we should be able to get the timing exactly right.

But for the timing to be “exactly right” we want to be able to place the sperm before the egg is released. We say a released egg is viable for twenty-four hours but we know from watching eggs in the lab that they are really optimized in their first six hours upon release.

Sperm, while functional for up to five days, is almost always very functional for the first twenty-four hours. That means we want to place the sperm into the womb before the egg is released, ideally the day before, so that they will be available when the egg is available.

The challenge with placing it the day before, however, is that while we are organizing for the insemination, we don’t actually know if the egg is going to be released on time.

To ensure the egg is ready on time, we often encourage using a “trigger shot”. This is an HCG hormone. It is actually a pregnancy hormone – and after a trigger shot, if you did a home test, it would suggest that you were pregnant. We use HCG because it is almost exactly the same structure as LH, the natural hormone that releases eggs. By taking the HCG shot, you can ensure yourself and us that the timing of the insemination will be ideal.

Different clinics will have different approaches. And it’s important to make note, it hasn’t been proven that HCG shots improve pregnancy rates.

 

2. Should you do one or two intrauterine inseminations?

 

The worry is that the timing of the insemination may not have been perfect. For that reason, it may be helpful to do inseminations two days in a row. If one insemination is too early (or the other is too late), at least one of them will be ideally timed. So is it worth doing IUIs two days in a row?

You can discuss this with your clinic. Pregnancy rates that peak at 30% are frustrating: It means that 70% of patients at least won’t succeed with their insemination cycle.

At my clinic, we do the double IUIs as our standard of care, not because we know that it increases pregnancy rates – we can’t know that – but because we are certain that it helps to minimize the stress of all involved. Everybody needs to be able to look back on the IUI and know that it was done in the best possible way.

Having said that, when it comes to donor sperm, which is so much more expensive, we generally encourage a single insemination. Clearly, every clinic is going to have a different opinion on this approach.

As long as you find a clinic and solution that minimizes your stress and maximizes your comfort level, then you have the best approach that fits you.

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